One important learning from the two-and-a-half-year COVID-19 pandemic is that the public health emergency (PHE) waivers made an enormous difference for hospitals and health systems. While the waivers were meant to quickly pivot to address the challenges hospitals and health systems faced during the PHE, some of them are worth keeping permanently.
In a July 29 letter to Department of Health and Human Services Secretary Xavier Becerra, the AHA pressed the case for extending the PHE past its current expiration date in October. That’s because the regulatory flexibility afforded to caregivers — the expanded ability to deal with COVID-19 surges and design approaches that best meet the needs of their communities — has demonstrated its value time and again.
We deeply appreciate the support that HHS has provided during the pandemic. Among other benefits, waivers have allowed for hospital bed flexibilities, expanded access to telehealth services, supported the establishment of hospital at home programs, enhanced the ability of health care professionals to practice across state lines, and offered providers relief from administrative burdens. The PHE declaration has also made possible several critical coverage and hospital payment policies.
You have spoken out about this, and we’re making sure Washington, D.C., hears you loud and clear. We shared the results of our recent survey of some of our hospital and health system members to ascertain whether the COVID-19 waivers continued to be essential.
93% said their hospital would be negatively impacted if the waivers were rolled back, with 60% saying it would be significant;
89% told us they still depend on the flexibilities provided by the PHE waivers to deliver needed care;
78% said the waivers provide important support in managing ongoing staffing issues and shortages;
72% indicated that the waivers were extremely important to their hospital or health system; and
72% said that the withdrawal of the waivers would significantly affect their patients’ access to health coverage.
It’s clear that now is not the time to eliminate these vital flexibilities. The B.A.5 variant has brought a rise in hospitalizations and deaths and many providers are seeing sicker patients. Hospitals continue to grapple with a host of issues including supply chain disruptions, rising labor costs, a sharp uptick in the demand for mental and behavioral health services, and most importantly, significant shortages of doctors, nurses, pharmacists, therapists and other health care personnel.
The waivers have played a vital role in managing this prolonged and unpredictable pandemic. But their impact goes deeper. Hospitals have often utilized these temporary policies as a catalyst for establishing new, innovative and safe ways for delivering patient-centered care … helping chart the way to a bright future.
For these reasons, we will continue to fight for some of these valuable waivers to become permanent Medicare policy, and others to stay in place long enough to ensure a smooth shift to a post-public health emergency world.
The US Centers for Disease Control and Prevention is expected to update its guidance for Covid-19 control in the community, including in schools, in the coming days, according to sources familiar with the plan.
A preview of the plans obtained by CNN shows that the updated recommendations are expected to ease quarantine recommendations for people exposed to the virus and de-emphasize 6 feet of social distancing.
The agency is also expected to de-emphasize regular screening testing for Covid-19 in schools as a way to monitor the spread of the virus, according to sources who were briefed on the agency’s plans but were not authorized to speak to a reporter. Instead, it says it may be more useful to base testing on Covid-19 community levels and whether settings are higher-risk, such as nursing homes or prisons.
The changes, which may be publicly released as early as this week, were previewed to educators and public health officials. They are still being deliberated and are not final.
In a statement to CNN, the agency said, “The CDC is always evaluating our guidance as science changes and will update the public as it occurs.”
As part of the expected changes, the CDC would also soon remove a recommendation that students exposed to Covid-19 take regular tests to stay in the classroom. The strategy, called “test to stay,” was recommended by the agency in December, during the first Omicron wave, to keep unvaccinated kids who were exposed but didn’t have symptoms in the classroom instead of quarantining at home.
Test-to-stay was resource-intensive for schools, and some districts had voiced concerns about having enough money to continue, one source said.
In schools and beyond, the agency will no longer recommend staying at least 6 feet away from other people as a protective measure. Instead, the new guidelines aim to help people understand which kinds of settings are riskier than others because of things like poor ventilation, crowds and personal characteristics like age and underlying health.
The CDC is also set to ease quarantine requirements for people who are unvaccinated or who are not up to date on their Covid-19 vaccines. Currently, the agency recommends that people who aren’t up to date on their shots stay at home for at least five days after close contact with someone who tests positive for Covid-19. Going forward, they won’t have to stay at home but should wear a mask and test at least five days after exposure.
People who are sick with Covid-19 should still isolate, the agency is expected to say.
The agency also plans to re-emphasize the importance of building ventilation as a way to help stop the spread of many respiratory diseases, not just Covid-19. It plans to encourage schools to do more to clean and refresh their indoor air.
Sources say the tweaks reflect both shifting public sentiment toward the pandemic – many Americans have stopped wearing masks or social distancing – and a high level of underlying immunity in the population. Screening of blood samples suggests that as December, 95% of Americans have had Covid-19 or been vaccinated against it, reducing the chances of becoming severely ill or dying if they get it again.
The CDC’s recommendations are not legally binding. Many cities, states and school districts will review them but may ultimately follow different strategies.
One example of this is masks in schools.
More than 200 million people – about 60% of the total population – live in a county with a “high Covid-19 community level” where the CDC warns of a risk of strain on the health care system and recommends universal indoor masking.
Yet most schools have kept masks optional for students this year. Among the top 500 K-12 school districts, based on enrollment, about 98% do not require masks, according to the data company Burbio’s school policy tracker.
Still, the agency’s guidance continues to be important as a baseline. When cities or states try to go beyond what the CDC recommends, they may face pushback.
“COVID is over” might trend within social media circles, but weekly U.S. death tolls tell a different story.
Despite a slight uptick in July, the pace of COVID-19 deaths has remained steady since May at about 400 a day, according to a USA TODAY analysis of Johns Hopkins University data.
“We’re sitting on this horrible plateau,” said Dr. Daniel Griffin, an infectious disease specialist with Pro Health Care in New York and a clinical instructor of medicine at Columbia University. “It’s been this way for the past couple of months, and we’re getting used to it.”
In July, more than 12,500 Americans died of COVID-19, according to the USA TODAY analysis.
Coronavirus deaths are similar to the number of influenza deaths normally reported during peak season, said David Dowdy, epidemiologist at the Johns Hopkins Bloomberg School of Public Health. A bad flu season in the USA could see more than 50,000 deaths.
That doesn’t mean COVID-19 mortality has reached that of flu, he said, as peak flu season lasts only about three months. Spread over the course of the year, Dowdy said, there would be about four times as many COVID-19 deaths than flu deaths.
COVID-19 is “like having to live in flu season year round, and that’s not what we do with the flu,” he said. “If we had to do that with the flu, we’d be instituting more measures than what we do.”
Most Americans who died of COVID-19 were immunocompromised or older than 75, experts said. These patients ranged in vaccination status – from being unvaccinated to receiving all their recommended vaccines and boosters.
What appears to make the biggest difference between patients who recover from COVID-19 or die, Griffin said, is whether they receive treatment within the first week of diagnosis.
“I can’t remember someone in my recent memory who did all the right things, who got the vaccine and got the proper early treatment, and ended up in the hospital and died,” he said.
The antiviral Paxlovid, from Pfizer, has been effective at keeping high-risk COVID-19 patients out of the hospital. But it’s losing esteem among providers and patients as public figures report rebound infections after taking the antiviral, Griffin said.
Although it appears more rebound infections are reported, Dr. Ashish Jha, the White House’s COVID-19 response coordinator, said the rate of cases is probably about 5%. Most people aren’t tested as often as health officials, Jha said in a series of tweets Monday.
It’s not clear whether a rebound after taking the antiviral is different from a rebound without the drug. In the trial that led to Paxlovid’s authorization, 2% of those who took the medication and nearly the same percentage of those who didn’t experienced rebounds.
The uncertainty surrounding antivirals and other COVID-19 treatments may contribute to preventable deaths, Griffin said.
“A lot of clinicians are reading the popular press, and that’s where they’re getting their impression of things,” he said. “You have a five-day opportunity to reduce the disease progression, and once that window is closed, it’s closed.”
A monoclonal antibody called Evusheld fromAstraZeneca prevented severe disease in people with weakened immune systems who may not get full protection from vaccines. It provides long-lasting protection, but Griffin said some providers don’t recommend it to eligible patients.
“It’s not an easy lift,” he said. “You can’t just write a prescription. It’s still only being sent to certain places, and there’s a whole process for getting your patient enrolled.”
Some physicians consider it “an uncompensated and time-consuming lift,” he said, and prescribe other medications that aren’t suitable for early treatment, such as high-dose steroids.
“The vaccines we already have are still highly effective against serious illness and deaths … so I don’t think the bivalent vaccines are going to be a game changer in that regard,” Dowdy said. “What they may do is help curb transmission somewhat because they may be more effective against infection.”
Experts said what will protect those at high risk of severe COVID-19 and death is staying up to date on recommended vaccines and seeking early treatment with proven therapies.
“This plateau now, as horrible as it is, is unfortunately lower than it’s going to be if we don’t do a great job this fall with boosters and improving education about how to properly manage COVID,” Griffin said.
Contributing: Karen Weintraub, USA TODAY. Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.
Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.
LONDON/CHICAGO, Aug 1 (Reuters) – As the third winter of the coronavirus pandemic looms in the northern hemisphere, scientists are warning weary governments and populations alike to brace for more waves of COVID-19.
In the United States alone, there could be up to a million infections a day this winter, Chris Murray, head of the Institute of Health Metrics and Evaluation (IHME), an independent modeling group at the University of Washington that has been tracking the pandemic, told Reuters. That would be around double the current daily tally.
Across the United Kingdom and Europe, scientists predict a series of COVID waves, as people spend more time indoors during the colder months, this time with nearly no masking or social distancing restrictions in place.
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However, while cases may surge again in the coming months, deaths and hospitalizations are unlikely to rise with the same intensity, the experts said, helped by vaccination and booster drives, previous infection, milder variants and the availability of highly effective COVID treatments.
“The people who are at greatest risk are those who have never seen the virus, and there’s almost nobody left,” said Murray.
These forecasts raise new questions about when countries will move out of the COVID emergency phase and into a state of endemic disease, where communities with high vaccination rates see smaller outbreaks, possibly on a seasonal basis.
Many experts had predicted that transition would begin in early 2022, but the arrival of the highly mutated Omicron variant of coronavirus disrupted those expectations.
“We need to set aside the idea of ‘is the pandemic over?'” said Adam Kucharski, an epidemiologist at the London School of Hygiene and Tropical Medicine. He and others see COVID morphing into an endemic threat that still causes a high burden of disease.
“Someone once told me the definition of endemicity is that life just gets a bit worse,” he added.
The potential wild card remains whether a new variant will emerge that out-competes currently dominant Omicron subvariants.
If that variant also causes more severe disease and is better able to evade prior immunity, that would be the “worst-case scenario,” according to a recent World Health Organization (WHO) Europe report.
“All scenarios (with new variants) indicate the potential for a large future wave at a level that is as bad or worse than the 2020/2021 epidemic waves,” said the report, based on a model from Imperial College of London.
Many of the disease experts interviewed by Reuters said that making forecasts for COVID has become much harder, as many people rely on rapid at-home tests that are not reported to government health officials, obscuring infection rates.
BA.5, the Omicron subvariant that is currently causing infections to peak in many regions, is extremely transmissible, meaning that many patients hospitalized for other illnesses may test positive for it and be counted among severe cases, even if COVID-19 is not the source of their distress.
Scientists said other unknowns complicating their forecasts include whether a combination of vaccination and COVID infection – so-called hybrid immunity – is providing greater protection for people, as well as how effective booster campaigns may be.
“Anyone who says they can predict the future of this pandemic is either overconfident or lying,” said David Dowdy, an infectious disease epidemiologist at Johns Hopkins Bloomberg School of Public Health.
Experts also are closely watching developments in Australia, where a resurgent flu season combined with COVID is overwhelming hospitals. They say it is possible that Western nations could see a similar pattern after several quiet flu seasons.
“If it happens there, it can happen here. Let’s prepare for a proper flu season,” said John McCauley, director of the Worldwide Influenza Centre at the Francis Crick Institute in London.
The WHO has said each country still needs to approach new waves with all the tools in the pandemic armory – from vaccinations to interventions, such as testing and social distancing or masking.
Israel’s government recently halted routine COVID testing of travelers at its international airport, but is ready to resume the practice “within days” if faced with a major surge, said Sharon Alroy-Preis, head of the country’s public health service.
“When there is a wave of infections, we need to put masks on, we need to test ourselves,” she said. “That’s living with COVID.”
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Reporting by Jennifer Rigby and Julie Steenhuysen; Additional reporting by Maayan Lubell; Editing by Michele Gershberg and Bill Berkrot
It may seem like a bad dream, but it’s for real. The COVID-19 virus is surging yet again. New variants like the Omicron BA.5 subvariant are raging through unvaccinated populations in the U.S. and elsewhere around the world. The variants are also pushing through the immunity barriers of vaccines and previous infections. As summer fades into winter, public health experts worry that the pandemic will explode again, and employers should start taking steps now to protect their employees, customers and clients.
On COVID-19, It’s déjà vu all over again
Clinic-based COVID-19 testing has been falling out of practice, which means that the number of confirmed positive cases understates the extent of the resurgence. A more accurate indication is the presence of the virus in wastewater, which the U.S. Centers for Disease Control (CDC) adopted as an early warning system during the first outbreak in 2020.
“Data from wastewater testing support public health mitigation strategies by providing additional crucial information about the prevalence of COVID-19 in a community,” CDC explains, noting that “wastewater surveillance captures presence of SARS-CoV-2 shed by people with and without symptoms.”
“By measuring SARS-CoV-2 levels in untreated wastewater over time, public health officials can determine if infections are increasing or decreasing in a sewershed,” they add.
On July 26, Fortune Magazine reported on a wastewater surveillance partnership between Stanford University, Emory University and Alphabet’s Verily precision health branch (formerly Google Life Sciences). According their data, COVID in many locations throughout the U.S. is at or around levels seen during the initial Omicron surge in January, which was the most recent peak level of the pandemic.
That trend is consistent with online COVID-19 trackers, such as the daily updates provided by NBC News, which indicate a recent uptick in hospitalizations and deaths.
Help is on the way
The good news is that the current COVID-19 vaccines are still highly effective at preventing severe symptoms leading to hospitalization, long term illness or death from the new variants.
In addition, last month the U.S. Food and Drug Administration advised manufacturers to create a new “bivalent” booster shot focusing specifically on the BA.4 and BA.5 Omicron subvariants. Contingent on FDA and CDC approvals, plans are already in motion to distribute a total of 171 million doses of the new bivalent vaccines from Pfizer and Moderna this fall and winter.
The plans also include an option to purchase an additional 600 million doses from the two companies combined. However, that additional purchase would require approval from Congress.
How long is long enough?
Until more effective vaccines against the variants are available, employers need to reassess their COVID-19 safety precautions. That includes the length of time employees should isolate after testing positive for the virus.
At the beginning of the outbreak, isolating for 10 days or more was advised. However, based on the growing body of knowledge about infection risks, last December CDC recommended shortening the isolation period to five days, followed by five days of wearing a mask when around other people.
“The change is motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after,” CDC explained.
That seems straightforward enough, but it’s not a cookbook recipe. Even though the risk of transmission drops off quickly, a certain measure of risk is still present, and employers need to take that into consideration.
One helpful tool is an online isolation calculator created by CDC. It is designed for use by the general public, to help tailor the isolation period to the particulars of an individual case.
Employers can also follow the guidance provided by President Joe Biden, who contracted COVID-19 in July.
The president prepared for a minimum of five days in isolation, in accordance with the general guidelines, but he also made it clear that he would remain in isolation until testing negative.
“Consistent with White House protocol for positive COVID cases, which goes above and beyond CDC guidance, he will continue to work in isolation until he tests negative. Once he tests negative, he will return to in-person work,” read the official White House statement on July 21.
A guidebook for employers on COVID-19
President Biden tested negative after the fifth day of isolation. Since then, he has used his case as an opportunity to remind the public – including employers — about common sense steps to reduce the spread of COVID-19, and to prevent serious illness or death from COVID-19.
He presented the information in his first official remarks after returning from isolation on July 27, at a public event in the Rose Garden. In summary, the guidelines for employers are: continue to take COVID-19 seriously; isolate when necessary; work remotely when warranted; ensure proper ventilation in the workspace (employers should also attend to overall wellbeing in the workspace); see to it that employees have access to free home test kits, available through online order at covid.gov; advocate for masks to reduce the risk of infection in crowded indoor spaces (including masks in the workspace if necessary; and, educate employees about Paxlovid and other antiviral treatments, as Paxlovid can be dispensed at many pharmacies without a doctor’s prescription.
In addition, employers continue to advocate for vaccination. In particular, ensure that vaccinated employees are up to date on their booster shots. A convenient vaccination locator is available at vaccines.gov. Another site, Covid.gov, also provides information on “test to treat” sites where patients can get tested for COVID-19 and receive Paxlovid at the same location (some states also offer free telehealth consultations for Paxlovid).
COVID-19 prevention is for everyone
During his remarks, President Biden also emphasized that his case illustrates the democratic state of COVID-19 prevention and treatment today.
In contrast to the helicopter transportation, extended hospital stay and exclusive drug cocktails needed to treat former President Trump for COVID-19 in the fall of 2020, President Biden had the advantage of widely available new vaccines and booster shots, as well as the widely available drug Paxlovid.
He experienced only mild symptoms and was able to recover in the White House residence and offices while continuing to fulfill his duties as Commander-in-Chief.
“The difference is vaccinations, of course, but also three new tools free to all and widely available. You don’t need to be a President to get these tools used for your defense. In fact, the same booster shots, the same at-home test, the same treatment that I got is available to you,” he emphasized.
“Get vaccinated if you haven’t gotten it already. And now, get boosted. Order your free test. And if you get sick and test positive, seek treatment. Take advantage of these lifesaving tools. We have more of these tools than we ever had before,” he added. That’s a message every employer should know by heart.
President Biden tested positive for the coronavirus again Saturday, the White House said, an example of Covid-19 “rebound” that can occur after people take the oral antiviral Paxlovid.
Biden is not experiencing any symptoms but is isolating again, according to his physician, Kevin O’Connor. Biden, who is vaccinated and has received two boosters, is not starting any Covid treatments at this time.
Biden, 79, first tested positive on July 21, and after a mild case, tested negative this past Tuesday. He tested negative each day the rest of the week — the White House said he had upped his testing frequency following his infection — but tested positive again Saturday morning.
“This in fact represents ‘rebound’ positivity,” O’Connor wrote in a memo Saturday.
Such rebound cases following treatment with Pfizer’s five-day oral antiviral have stumped physicians as they’ve tried to understand how frequently it’s occurring and what’s allowing the virus to come back a second time.
While some rebound cases are asymptomatic — like Biden’s thus far — other people see their symptoms return.
Folks, today I tested positive for COVID again.
This happens with a small minority of folks.
I’ve got no symptoms but I am going to isolate for the safety of everyone around me.
I’m still at work, and will be back on the road soon.
Rebound cases have raised such questions as whether Paxlovid should be prescribed for longer courses and for which patients it should be recommended.
Pfizer’s clinical trials showed rebound in 1% to 2% of patients, but in both patients who took Paxlovid and those who received placebo. But there have been enough anecdotes about Paxlovid rebound that many infectious disease physicians believe the rate could be higher. Anthony Fauci also had a rebound case after taking Paxlovid.
One theory for what’s allowing rebound is that the drug wipes out most of the virus before the body has a chance to recognize what’s happening and build up its full immune arsenal. If there are little pockets that manage to survive the treatment, they can start replicating again once the course of Paxlovid is finished. Other experts have wondered if it has something to do with the Omicron variant specifically. (The trials took place when the Delta variant was dominant.)
After Julianne Cline went out and got tested for COVID-19 this June, text messages and voicemails soon piled up from Los Angeles County contact tracers who wanted to talk to her.
Cline, 32, ignored them. She had been sick for days, and by the time she roused herself from bed to get officially tested, it seemed like “by the time they would have done any contact tracing, it would have been so long that those folks would have likely already gotten sick,” the Manhattan Beach resident said.
Besides, she said, “I just didn’t feel comfortable sharing my personal experience with the county.”
As the pandemic has dragged on, L.A. County contact tracers have struggled to reach and interview people with COVID. In January, amid a crush of cases driven by the Omicron variant, there were weeks when contact tracers were reaching and interviewing less than 10% of their assigned cases, county data show.
This summer, that number has stagnated below 30% in recent weeks — better than during the winter surge, but far below the success rates seen for L.A. County contact tracers earlier in the pandemic. And even when they have coaxed people to be interviewed, few of those phone calls led to additional conversations with others who they might have exposed, county statistics show.
Many more COVID cases are probably never being assigned to contact tracers at all, as many Angelenos rely on home tests that are never reported to the county.
Cline, for instance, had already tested positive on a home test days before she decided to confirm her case with a PCR test. At the University of Washington, researchers have estimated that fewer than 14% of positive cases across the United States are being detected and reported in official counts.
The end result is that only a fraction of COVID cases are being traced with phone calls to alert others and try to prevent more infections.
Experts say that contact tracing, long valued as a tool to quash the spread of viruses, has become an increasingly Sisyphean task in the face of rampant COVID infections, ever-more-contagious subvariants, and an exhausted public.
Contact tracing “is not really making the impact that it did at one point,” said Adriane Casalotti, chief of government and public affairs with the National Assn. of County and City Health Officials. “With communities broadly reopened, it’s very difficult to say how many contacts you had, and even if you can say that, you may have 20 or 30 or 40 contacts. … The logistics of actually contacting those people is very difficult. There’s not enough time in the day.”
“It really shortens the amount of time that you have to get a hold of somebody,” said Richard S. Garfein, professor at the UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science. “Having cases be willing to talk to a case investigator and identify who their contacts are — and then being able to turn around and notify those contacts within 24 to 48 hours — is becoming really challenging.”
In March 2020, the thinking was “this is a brand-new pandemic and we can hopefully stop it in its tracks, or blunt the impact and buy people time from spreading it further until we get a vaccine,” said Andrew Noymer, associate professor of population health and disease prevention at UC Irvine.
Now, “I just don’t see that we’re going to contact trace our way out of this,” Noymer said, especially as people have kept mingling but stopped wearing masks. He argued that the time and money should instead be devoted to other efforts, such as expanding PCR testing for the coronavirus, or redeploying contact tracers to track down monkeypox.
Earlier this year, the Centers for Disease Control and Prevention stopped recommending universal contact tracing for COVID-19, instead urging health departments to focus such efforts on high-risk settings such as long-term care facilities and jails.
Many cities have halted or pared back their efforts: Washington, D.C., laid off workers in June, putting an official end to its coronavirus contact tracing program, the Washington Post reported. New York City said it was ending its main program this spring.
At one point, L.A. County had enlisted roughly 2,800 contact tracers to find people who had tested positive and reach out to contacts who they might have exposed. By July, the county had roughly 100 staffers dedicated to contact tracing for COVID-19 — a fraction of the work force it once devoted to the effort.
The L.A. County Public Health Department said that its “limited resources (are) being focused on other strategies, including vaccines and therapeutics, that were not available earlier in the pandemic.” Its contact tracers are now giving priority to cases among elderly people and those in “high risk” ZIP Codes, a spokesperson said.
It has also started sending out an online interview by cellphone and email to allow people “to complete the case interview at their own pace and on their own time,” the department said.
A separate team is still dedicated to tracing cases at nursing homes and correctional facilities. And as monkeypox has arisen as a public health threat, L.A. County has also launched contact tracing for the disease: Roughly 200 public health nurses who do disease investigations in L.A. County are now doing contact tracing for monkeypox as part of their duties, according to the public health department.
Experts said that monkeypox may be better suited to contact tracing than COVID because it is harder to transmit, is at lower numbers, and has a longer incubation period.
Alexander Morgan, who worked up until recently as a contact tracer through an L.A. County contractor, was dismayed that the county had cut back on the number of contact tracers for COVID as case numbers remain high.
“It doesn’t make any sense,” Morgan said. “You want experienced contact tracers during a surge. It’s like a hospital gutting their staff.”
Morgan said that in the winter, as cases piled up, contact tracers made fewer attempts to reach people before abandoning those cases. At one point in January, L.A. County contact tracers were only phoning about a quarter of their assigned cases within a day, county data show.
By July, contact tracers were again reaching out to the vast majority of their assigned cases within a day, according to county figures. But the majority of those attempts were not ending with a successful interview. Morgan said that many people he had dialed would say, “I don’t have time for this.”
Cline, the Manhattan Beach resident who ignored calls from contact tracers, said that at one point she started getting text messages offering her gift cards if she called them back. That only made her more skeptical. “I was like, ‘Is this a scam?’” she said.
It wasn’t: The county Department of Public Health said it is, in fact, offering gift cards through its contact tracing program.Garfein said that more than two years into the pandemic, “unfortunately, I think the public is burned out — and I don’t know how to get it back.”
Even when contact tracers do reach people who tested positive for the coronavirus, the trail often runs cold after that.
In a recent week in July, L.A. County contact tracers were assigned nearly 24,000 cases; successfully interviewed fewer than 5,000 of those people; identified 466 contacts from their calls and ultimately interviewed only 62 of those contacts, according to county data.
Even if relatively few people are reached, contact tracing can have other benefits, health officials have pointed out. Besides preventing the spread of cases, the phone calls can connect people to county assistance and encourage vaccinations and booster shots.
“Any contact tracing is good contact tracing — as long as the resources are not being taken from other things that are more effective,” said Dr. John Swartzberg, a clinical professor emeritus at UC Berkeley School of Public Health. Right now, “there’s just so much COVID that contact tracing is playing a minor role.”
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But “contact tracing can be incredibly valuable at keeping us at a very low level” when cases have fallen, Swartzberg said. And if public health departments give up on such programs when cases are overwhelming, it can be difficult to reestablish them when contact tracing could be more effective, Swartzberg argued.
“Dismantling the infrastructure for being able to effectively do contact tracing does not serve public health at all,” said Dr. George Rutherford, an epidemiology professor at UC San Francisco. In recent decades, “public health has been systematically dismantled and underresourced. We paid the price during COVID. We don’t want to pay the price again.”
Rutherford added that although the incubation period for the latest variants is short, making it tougher to reach people before infections spread, such calls can also alert people who might have been exposed to get tested and treated more promptly. If 80-year-olds have been exposed, “you want to start them on Paxlovid if they’re positive,” Rutherford said.
“There are probably certain situations in which it’s highly warranted — like a nursing home — and others like a rock concert or walking around downtown Los Angeles where you couldn’t name your contacts anyway,” Rutherford said.
Dr. Christopher Longhurst, chief medical officer for UC San Diego Health, said that another tool — anonymous notifications of COVID exposures through a smartphone app — can continue to help control infections by alerting strangers who spent time unmasked around someone who tested positive.
The CA Notify app, promoted by the California Department of Public Health, is now estimated to have 7.5 million active users and is notifying an average of five people every time someone reports that they tested positive, said Longhurst, who has helped manage and assess the system.
The results are still being evaluated, but “we’re clearly helping to prevent hundreds of thousands of infections,” Longhurst said.
Cline said she hadn’t activated any app to alert people who might have been around her while she was infected.
“If I were asked to share all the places I had been and all the people I’d seen — there would be likely hundreds that could have passed by me,” she said. “We’re not in a place anymore where your one interaction a week may have been with just four people.”
QUINCY – After a downward turn, the number of COVID-19 cases on the South Shore rebounded this week while the statewide count was up for the fourth straight week and the number of confirmed cases topped 1.8 million, showed the latest reports issued by the state Department of Public Health on Thursday.
And while the number of people in the hospital with the virus increased in the past week, the number of patients being treated primarily for COVID-19 related illnesses and the most serious cases has declined, the agency said.
Case counts increased in 16 of the 23 South Shore communities surveyed, the state reported in its weekly breakdown of cases by municipality.
The statewide rise in cases comes amid growing dominance of the latest COVID-19 variant, BA.5, which is the most infectious yet and its believed to account for about three-quarters of the nation’s cases. The new variant is infects people who are vaccinated and fully boosted as well as those who gained immunity from prior infections.
The Centers for Disease Control reports 90.75 million COVID-19 cases in the United States over the more than two years of the pandemic.
On the South Shore, there were 1,478 cases during the two weeks ending July 23. That is an increase of 7.7% from the two week period ending July16, when there were 1,372 cases.
The statewide increase was 3.2%, with 20,016 cases for the two weeks ending July 23 compared to 19,394 for the two weeks ending July 16. The statewide rate rose from 19.7 cases per day per 100,000 people averaged over two weeks to 20.3 in the latest report. It is the fourth straight week the statewide numbers have gone up.
Only lab-confirmed cases are included in the state health department report, not ones found with home test kits.
Nine local communities had rates higher than the statewide average of 20.3 cases per day per 100,000 people. They are Randolph, with a rate of 27.4, Carver with a rate of 25.1, Holbrook with a rate of 24.4, Hull with a rate of 23.4, Pembroke with a rate of 23, Braintree with a rate of 22.1, Kingston with a rate of 21.4, Plymouth with a rate of 20.9 and Norwell with a rate of 20.8.
The town with the lowest rate was Halifax with 7.4.
In Thursday’s weekly report, the state health department said there were 9,954 COVID-19 cases over the seven days ending Wednesday, bringing the state’s total for the pandemic to 1,803,391.
There were 616 people in the state’s hospitals with COVID-19, an increase of 27 patients from a week earlier. Of these, 171 are being treated primarily for COVID-19 related illnesses, 18 fewer than a week earlier. There were 48 patients in intensive care units with COVID-19, down four from a week ago, and 19 on breathing equipment, down one from a week before.
The state reported 38 new COVID-19 deaths over the past week, bringing the total for the pandemic to 19,898.
The following is a list of the number of cases by community for the two weeks ending July 23, the average daily rate of cases per 100,000 people over the two-week period and the total number of cases since the pandemic began. The statistics do not include the results of home tests.
Spokane, Wash. – The Western States Scientific Safety Review Workgroup reviewed the federal process and has recommended authorized emergency use of the Novavax COVID-19 vaccine for the prevention of COVID-19 to include use in adults ages 18 and older. Spokane Regional Health District (SRHD) supports their recommendation and will begin offering doses to providers through their vaccine depot as soon as vaccine shipments arrive.
Dr. Francisco Velázquez, health officer for SRHD, said, “Novavax gives people a more traditional, protein-based COVID-19 vaccine option, one they may be more comfortable with. We are excited to have four vaccine options that are excellent at the prevention of COVID-19, including the prevention of severe symptoms and outcomes that result in hospitalization and mortality.”
The Novavax COVID-19 Vaccine, Adjuvanted, is administered as a two-dose primary series, three weeks apart. The vaccine contains the SARS-CoV-2 spike protein and Matrix-M adjuvant. Adjuvants are incorporated into some vaccines to enhance the immune response of the vaccinated individual.
Velázquez encourages families to connect with their healthcare provider to learn more about the vaccines and to find out if their healthcare provider is offering the Novavax COVID-19 vaccine if that is the vaccine you prefer.
Velázquez explained as more of our population can be fully vaccinated against COVID-19, the less we’ll see of virus transmission and hospitalizations, and the safer it is for all members of the community to return to public activities and the freedom to be around others.
It is prudent to reach out to your provider or pharmacy before visiting in person, as not all providers are offering the vaccine. Vaccine shipments are expected to arrive from the Washington State Department of Health this week.
“The vaccines continue to be effective in reducing risk of severe disease, hospitalization, and death, including against the Delta and Omicron variants. We continue to see highly effective protection against hospitalizations and severe outcomes for people who are fully vaccinated,” said Velázquez.
Those who are eligible for the initial vaccine series or a booster are encouraged to use DOH’s VaccineLocator.doh.wa.gov website or call the COVID-19 Information Hotline at 1-800-525-0127, then press # to be directed to vaccine providers in Spokane County. Language assistance is available. In addition, the SRHD website provides a map of those providers who offer the pediatric vaccines.
COVID-19, and the emotional and physical toll it caused, reached all corners of the globe. At a nursing home in Hawaii, the staff describes how the pandemic has affected them.
Studies show that the potential for moral injury to health care workers working with COVID-19 is relatively high, leading to burnout and impairing mental health. I asked my clients at a nursing home in Hawaii to tell me how the pandemic had affected them. They wrote this article.
March 2020 is a date that is forever imprinted on our minds, hearts, and the history books. Those of us who dedicate our lives to the world of long-term care and caring for our kupuna [elders], we all shared a heightened sense of fear and anxiety, as we watched the introduction of SARS-CoV-2 (COVID-19) to long-term nursing facilities. A virus that changed the landscape of what we do. COVID-19 continued its relentless spread throughout the world, nation, and facilities, infecting millions and killing hundreds of thousands more. The long-term care industry was facing its fiercest challenge yet: to protect a population burdened by frailty.
For all of us in long-term care, work increased exponentially, with expanded regulatory compliance, health care staffing shortages, personal protective equipment shortages, and an unknown coronavirus. We found ourselves immersed in the stresses and fears of working in a crowded facility, asking ourselves and each other, “How do we survive each day, each shift, each hour, and keep our residents and ourselves safe?” It is difficult to put into words the hardships we faced and the relentless burden we endured. Only those who were, and are, in it, can understand the painstaking tasks we accomplished to battle this historic pandemic.
Two years later, we continue to fight COVID-19. We still face the challenge to protect our residents and staff. We still endure stress, fear, and surges of new variants among our population. All of this has become part of our daily routines and changed the way we view our work and our lives. Recently, our team took a step back to reflect. A common thought: “I can’t believe it’s been 2 years already.” A common question: “How did we get through this?” There is no simple answer, but to put it simply, teamwork and revising the way we view and approach the work we do.
It difficult to say that there is a silver lining, especially when hundreds of thousands kupuna lost their lives. But it is this silver lining that will save many more. As our team reflected, many positives surfaced to realization. First, we truly learned the meaning of teamwork. We broke down walls, silos, and the division of duties among departments to become 1 team, 1 facility. As Pam Calilao, medical records manager, put it, “During the outbreak, you’re not just ‘medical records’ anymore. You quickly learn how to do patient care, test your fellow co-workers for COVID-19, correctly wear your PPE. You become a member of the COVID-buster team to promote cleanliness in the facility.” Rachel McKean, Admissions Coordinator, added: “Our team worked so well together and put in so much work to get COVID-19 out of the building. Teamwork literally makes the dream work.”
Secondly, we all felt an increased responsibility about the work we do, and had a different perspective with how we approach it. Lindsey Oroku, a registered dietitian, shared her thoughts: “COVID-19 was a rude reminder to be grateful—grateful to have a job, grateful to have a job that helps others, grateful for health. Many people lost their jobs and the ability to live carefree, lost loved ones, and went through—and continue to go through—tough times. I feel like it’s better to go through tough days than tough times.”
Christina Seto-Mook, another registered dietitian, noted, “We knew so little about this virus and how much chaos it would create in our professional and personal lives. We learned how to be more flexible. It was great to see everyone working as a team and really putting in the effort to keep our residents safe. It wasn’t just about getting our own work done but about helping each other and taking that extra mile. Adaptability was another crucial aspect of managing COVID-19, as we were all experiencing and learning how to get through this unforgettable time together.”
Two years of this pandemic has developed strength, belief, and courage within all of us. We carry ourselves, our team—our ohana [family]—with pride, owning the hand we’ve been dealt, and conquering the adversity we have faced. Our accomplishments have strengthened our bond, cemented our goals, and taught us the true meaning of ohana. COVID-19 has forever changed the landscape of what we do. But the bond we have built during this pandemic— the team, the support, and empathy, will last forever. It has guided us through an adversity, unlike any other, and we believe that we can continue to conquer any challenge before us.
The words of Leina’ala Pilares, registered nurse and staff educator, sums up our pride, “Two years of unknowingness. I look into their [patients’] eyes, and I see hope. I go on for another day. Why? To protect the things I love. I have no fear when I choose to love and protect. I kept myself safe, isolated, and clean to protect my people and the residents I care for. Why do I work so hard? Because when I go to work, the next day I want to see the same faces I saw the day before. And then I tell myself, ‘COVID-19, you will never be welcome in my home. I have no aloha [love] for you. I stand proud to have kept you out of my homes for another day. E ku kanaka!” (We Stand Tall!)
We have struggled, endured, battled, and wept. But we have also empathized, bonded, rejoiced, and overcame. We found courage and strength within ourselves that we did not know existed. We continue to grow, to be grateful, and to be committed to health care, long-term care, and our kupuna. The lessons we learned hardened our foundation to overcome any adversity to provide the best care for them, and we look forward to doing this for many years to come.